Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shane Bannon

Individual provider Acute Care Nurse Practitioner · NPI 1245997220

Shane Bannon is a Nurse Practitioner in Philadelphia, Pennsylvania. Qualified in 2021, 5 years ago. Practices with University of Penn-Medical Group, a 3,401-clinician group and accepts Medicare assignment. Licensed in Pennsylvania.

Years since qualifying
5
Licensed in
PA
In the registry since
2021
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Practice location Address checks out

1 Convention Ave
Philadelphia, PA 19104-4311
Phone: (800) 789-7366
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence SP024901 (PA)

Record details

NPI number1245997220
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedNovember 24, 2021
Last updated in NPPESNovember 24, 2021
Certification dateNovember 15, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice University Of Penn-Medical Group — 3401 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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